CMS Looking at Acupuncture for Back Pain

CMS Looking at Acupuncture for Back Pain

By Ed Coghlan,

The Centers for Medicare & Medicaid Services (CMS) announced it is considering adding coverage of acupuncture for chronic low back pain. The notice states that HHS is focusing on providing more evidence-based non-drug treatment options for chronic pain in response to what agency calls “the opioid crisis” in the U.S.

The Agency for Healthcare Research and Quality published a systematic review of noninvasive, nonpharmacological treatment for chronic pain in June 2018. The review included assessment of several nonpharmacological interventions, including exercise, acupuncture, spinal manipulation, and multidisciplinary rehabilitation for CLBP. The National Institutes of Health recently issued a Funding Opportunity Announcement for interested parties to apply to conduct an efficient, large-scale pragmatic trial to evaluate the impact of, and strategies to best implement, acupuncture treatment of older adults (65 years and older) with chronic low back pain. The announcement can be found here.

CMS is opening this national coverage analysis (NCA) in order to review the evidence to determine if acupuncture for CLBP is reasonable and necessary under the Medicare program. The notice is available here.

Public comments are due February 14, 2019. CMS is particularly interested in comments that include scientific evidence and discuss appropriate clinicians and training requirements for providing acupuncture to improve health outcomes. For commenters recommending Coverage with Evidence Development (CED), CMS is interested in comments related to appropriate outcomes and study designs. Finally, CMS emphasizes that the scope of this review will be limited to acupuncture for chronic low back pain.

Acupuncture is an alternative therapy in which thin needles are inserted into the body, often to relieve pain. There are a diverse range of acupuncture theories based on different philosophies, and techniques vary depending on the country in which it is performed.

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Authored by: Ed Coghlan

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Hey. I really liked your article. I had acupuncture therapy several times. I want to tell you honestly, it really helps. Thus, acupuncture can work in some cases, but you should not pin hopes on it for infertility or other serious violations. Moreover, you should not get involved in acupuncture, and absolutely not worth contacting him without consulting a doctor. Yes, a placebo can work. But if you need serious treatment, the sooner you start it, the better. Therefore, I advise everyone, there is nothing dangerous about it. Good luck!

Jan

That’s great but acupuncture does not work for everyone . You cannot put us in one size fits all. What works for one person may not work for another. Leave our pain meds alone.

Lynn McDonough

I wish they would consider covering acupuncture for those that are on Medicare due to disability and not yet 65 years of age such as myself. I may benefit from acupuncture, but can’t afford it.

Tara

I can no longer afford acupuncture on my own. Acupuncture has helped with my back injury and my mother’s ciatica so much that it’s allowed my mother to stop using topical creams and pain pills to go to sleep!! It also reduced my inflamation to a point that allowed me to walk again and start PT. What it did for stress and anxiety I cannot begin to describe. It turns off your fight or flight mode and actually allows you to reboot your mind/ body. I don’t hold tension in my body like I did before acupuncture. My acupuncturist taught me how to take care of myself on my own and constantly adjusted the acupuncture session to the present issue. I cannot thank acupuncture enough.

Christina Smith Gardner

Acupuncture and other alternative treatments should had been covered by health insurance companies ages ago! Acupuncture has a high successful rate when it comes to pain management, immune system strengthening, and overall wellness.

Andrea

This is fabulous! Acupuncture works. It’s a no brainer to make it more accessible for pain management.

Kathleen Kaiser

My insurance Coventry/Aetna began coverage massage and acupuncture. But they will only cover 12 visits for acupuncture.

William

Just stop this madness and let us use what works. OPIOIDS.

This dont work and what about the people who takes warfine .they can’t do this .the cms need to leave chronic pain meds alone

Lisa Hess

Back in the 1990s I had a friend who was a licensed Acupuncturist so I got my treatments for free and I loved how I felt afterward, but I was there 3 times a week or whenever I needed it. Then I moved to a new town. In 1999 three years after my car accident I went to an Acupuncturist for my degenerative disc disease that was ravaging in my cervical spine. He also did botox trigger point injections. I did this for a year because it was helping me and I was not on any medication except for muscle relaxers at bedtime because my muscles throughout my neck would be in constant spasms and it helped for that, but again, I went three times a week. After a year those treatments stopped working and my cervical spine was getting worse and I needed surgery. About 4 years ago I was on a cruise but in excruciating pain from the C1 all the way to my feet because of the DDD and several other muscle/skeletal diseases I now have and I’m much older now. They offered acupuncture on the ship. This guy was a quack and only used one needle putting it in places he shouldn’t have which made me so much worse that I was in worse pain for the rest of our trip. If Medicare does approve it, and my entire spine, joints, and everything in between are in such turmoil that I have to take Opioids because we’ve tried everything and nothing works for me anymore because of too much damage and scar tissue so thick that needles cannot penetrate through it. Will I try it again, probably, but I know going in that it is just a temporary fix if it helps at all, which I don’t think it will, but I have to comply with Pain Management to try everything that becomes available. What I’m waiting for is for Medicare to approve a morphine pump for non cancer patients, but it is not bi-directional, so the jury is still out if I want to put another foreign object into my body to possibly reject.

Gail Honadle

Both Dr Lawhern and Dr Hall are correct, at 70 and having 2 forms of Arthritis, Degenerative Spine from C3 down to S1, FMS, Gastropresis, along with other health conditions, I’m a Complex Patient, that requires 4 main Specialist to Coordinate care and meds. No pain clinic has the qualifications to do so. Since Tennessee only has 65 left none run by a real Doctor, APN, NP, PA at most. Extreme Care has to be taken when prescribing for me.

Where is the HIGH in Oxycontin I keep reading about? That is what Street Junkies seek. I couldn’t do Yoga, I flunk Physio. Quit making me take Steroids what further destroy my bones before I can go to Physio after a Fall not simple ones, the ones you call the EMT’s and end up in the ER being treated like a Criminal for wanting 1 pain shot so you can travel back over rough rural roads. No wonder Vets, civilians are committing Suicide from INTRACTABLE PAIN. FORCED TAPERS short term can cause a heart attack for Cardio Patients.

Ortho won’t authorized Dry Needling, most he will do is Dry Cupping small relief of the damaged joint but not beyond that joint.

Alicia Connelly

I am using accuputure to get help with nerves that are being pinched in the area of my tailbone. I can set without being in a lot of pain. I am happy to say that the accuputure has helped. It has eased up the level of the pain. With more sessions I hope to have less pain and more movement. If you have back pain, don’t go to a orthopedic surgeon. Try accuputure first!!

Mary W.

To be specific: best acupuncture is Traditional Chinese Acupuncture and where I reside there are clinicians trained in China who are healers with this modality. No human should EVERY SUFFER! Or be subject to Gestapo interrogation if going to hospital….EVER.

Mary W.

Every person’s body is unique, and responds either quickly or slowly to acupuncture. Like titrating Rx opioids, there is no “One size fits all”. A patient’s acupuncture clinician SHOULD communicate in writing with their physician who is prescribing Rx opioids. There is no “One size fits all” for opioid medication nor acupuncture treatment; the human body is very complex and when dealing with migraine, cervicogenic headache, bone pain (the worst!), lower back pain, or post surgery pain – there are good days when healing begins and “bad days”. And a patient deserves to be diagnosed as an individual, especially when acute pain strikes. This 21st century model of physician care needs improvement – Vast improvement is needed! I am afraid to go to ER, even if I suffer with a 4 day upper cervical headache. Being mocked by nurses, accused of dishonesty or dealing with Gestapo-like questions after suffering for 4 days with upper cervical pain. No human being should suffer!

I’ve tried acupuncture many times it does not work for me. All physical therapist want you to do physical therapy & acupuncture at the same visits that way they can get the insurance money & your money charging anywhere from $60 for 15 minutes of acupuncture to $100 per 15 minutes of acupuncture. That’s a good racket to be in to get the money but financially draining for patients. I would consider this experimental because it doesn’t work for everyone. I don’t understand insurance companies willing to pay for acupuncture that’s so costly, experimental, no long-term studies done on it . yet will not cover opiates that cost extremely less & more broad-based working for just about all people except those who have allergy to the opiates. Insurance companies willing to pay out $20,000 to $50,000 on spinal interstims that doesn’t work for everyone & sometimes causes more damage to the spine. Yet will not cover a cheap medication like opiates. They say America has the highest health care cost & with the lowest results, we can thank our politicians for this. It’s all about the money not Patients centered health as it is wisely termed. All about sounding politically correct & receiving funds for more diagnostic codes to charge for while chronic pain people deteriorate.

Artemisia

Hello,
I’m fused from L/2- L5/S1, 2 amazing surgeries for deg disc disease. They were successful.
I have extensive nerve damage around the Sacral area that wraps around my hip.It splits into 4 different sciatic paths. Yes, 4 different sciaticas. Been living with this for years. Acupuncture makes my sciaticas go from a 7/8 on the pain scale to a 2/3. It lasts about 5 days. My wrap around pain goes away too. It all gradually comes back. I’ve been getting this treatment from the same acupuncturist since 1998.
It doesn’t help my back pain. I take gabapentin, motrin, and a low dose of both long & short acting pain meds. I have an awesome chiropractor too. I’m grateful I live in an area where there are many alternative health workers. These treatments work with the right practitioner.
I wish Medicare covered acupuncture. Without It I’d take alot more narcotics than I do now.
Thanks.

There is NO opioid crisis! I take 1/2 pill Oxy- Acetomenophen in AM to get moving/ cut pain and a sometimes another 1/4 pill or half!!! Yesterday my pain Doc. threatened cut me off because I shared I had more joint pain!!!! I have had multiple surgeries, degenerative discs , neuropathy, arthritis, fibromyalgia. Also arthrofibrosis in knee from TKR a surgeon messed up- I should not have to be frightened to relate that I have a spike in pain during winter!!! There is a drug ADDICT CRISIS!!! Go after THEM-

This is an interesting study. It would seem that AHRQ doesn’t believe its own systematic outcomes review, published last June. The following is a direct quote:

Chronic low back pain: At short term, massage, yoga, and psychological therapies (primarily CBT) (strength of evidence [SOE]: moderate) and exercise, acupuncture, spinal manipulation, and multidisciplinary rehabilitation (SOE: low) were associated with slight improvements in function compared with usual care or inactive controls. Except for spinal manipulation, these interventions also improved pain.

For acupuncture, there was no difference in pain at intermediate term, but a slight improvement at long term (SOE: low).

What this basically tells us is that the published trials data aren’t at all rigorous, so the jury is still out. One of the main problems is that none of the published trials data examined acupuncture as a replacement for “usual therapy”. But many government authorities want to impose non-opioid therapies precisely to replace opioids, while ignoring the lack of rigor in the data. This is a basic violation of accepted science.

F.S.T.

This may be fine for some, but I’m convinced that Acupuncture is more of a “spiritual” and probably a psychological thing. That it may work is no consolation. (I look at yoga the same way — its far Eastern mysticism is an absolute no-no to followers of Jesus. There is no such thing as Christian yoga, so don’t fool yourselves and I cringe at the number of Well-meaning churches who endorse and sponsor it. It releases the kundalini spirit amongst those who practice it. If you’re serious about your walk with Jesus, remember He warned about deception in the church in the last days. Do your research and listen to all sides, but consider what former yoga instructors who came out of it and what they have to say.) If I stepped on toes, if I hurt some feelings, if I’m not politically correct…

…….I do not apologize. Blessings!

Great… Acupuncture/acupressure is certainly not evidenced based anything except a good example of bad evidenced based garbage snake oil. It’s been proven over and over and over again to be no better than placebo. Government sponsored woo woo. No surprise there. Frickin’ junk non-science. Close enough for government work as they say I suppose.

Harriet Hall, MD

There is plenty of scientific evidence showing that the benefits of acupuncture are likely nonexistent, or at best are too small and too transient to be of any clinical significance. It seems that acupuncture is little or no more than a theatrical placebo. And a systematic review of systematic reviews of acupuncture for pain found only 4 conditions for which the systematic reviews agreed: in 3 cases they agreed that it didn’t work, and in the 4th case they agreed that it worked for neck pain. Why would a treatment for pain work only for pain in one part of the anatomy?

See: https://journals.lww.com/anesthesia-analgesia/fulltext/2013/06000/Acupuncture_Is_Theatrical_Placebo.25.aspx and https://journals.lww.com/pain/Abstract/2011/04000/Acupuncture__Does_it_alleviate_pain_and_are_there.11.aspx

If acupuncture improves health outcomes, it is only through the placebo effect. Serious side effects have been reported. It is unethical to recommend a placebo, particularly one with potentially fatal effects. Acupuncture has no place in rigorously science-based, ethical medical practice.

Maureen M.

It’s nice to see the consideration at least but…been there, tried that…didn’t work for my chronic spine related pain which also involves extensive nerve damage.

Geri

Rick R. Your reply is so correct, thank you for your comments.

Stephen

Really, and I mean seriously, sticking needles in my body is going to alleviate pain? Do I also need to take some rhino horn and bear gall bladder extracts? Placebo effect is possible for some I guess. I am going to need to see some reputable scientific studies before buying into this.

Mildred Bradway

Not unless you use lidokane to num the area & the cost is $5.00 a session. People who are disabled can’t afford $30.00 to see a Specialist. Not on limited income!

dave

LOL. You got to love DHHS and Congress. After so many millions of Americans suffered for so long from the careless neglect of providers and legislators, now DHHS pretends to address the issue by providing coverage for nonopioid treatments as they all have fallen in line that opioids are bad bad bad. The insincerity of govt and health care toward pain is only too clear. Lets ask them if they have developed robust adaptive treatment regimens based on comparative relative contribution analysis- there answer is a resounding no-they certainly don’t care that much about people suffering pain to carefully approach treatment for each individual. The careless and unjustifiable sloppiness of lawmakers continues with new and improved plans that, just like the past, they promote as wonderful and infallible. What they refuse to do is take a good hard look at their individual and collective moral social and political failures in pain care- some moral reconnaissance and reform themselves. They want us to believe in progress with no real change. What a canard. Its time for government to reform themselves and the proud and certain deans of medical school and medical organizations to engage in sober reflection on their failures. But perhaps I am hoping too much from them.Perhaps theyd rather us to suffer from their unreformed underpowered ways indefinitely and for their friends in govt, academia and industry to keep profiting indefinitely from suboptimal efforts and the morals behind those efforts. Let them try and prove me wrong- I could use a good laugh.

Barbara Snow

I too tried it for a while. It did not help. It doesn’t stop the spine from deteriorating. I guess it’s ok temporarily not for long term.

I have 6 diseases. Lupus is the one where I hurt from head to toe. Feels like I have a fever or flu everyday.
Would not work for me.

Billie McCurdy

I wish acupuncher would have worked for me. Unfortunately even the smallest little needle sends pain to my nerves. It’s hard for even my grandkids to hug me without it hurting. but I suck it up when they hug me not to let them know that I’m in pain. Even hurts to wear certain clothing it rubs against my skin. Back in 2005 I was electrocuted by a large TENS unit during therapy. The machine malfunctioned and threw me off the chair twice before they reach down to unplug the machine. Maybe if I am electrocuted again like that it will set things back to normal LOL there’s got to be a way to get rid of is chronic pain without having to take medication. And I have tried all medications from the rheumatologist and the neurologist. Unfortunately I seem to be allergic to a lot of different things. For now I just meditate in prayer.

Kathy

Acupuncture is good. It works.

Jacqueline Alexander

I have Multiple Sclerosis and between my Nerves and my muscles all tight and inflamed which is a ongoing & Chronic pain daily. Which my back and legs arms and my bones ache to the touch the Doctor are aware of my illness but still refuse to give pain medicine besides Tramadol for chronic pain.
Which do not work for my particular pain.
Thanks. J. Alexander

Harry

Tried it for about 4-6 months. It works, temporarily for about 1 day or when you return to your regular activities. I have spine issues & musculoskeletal pain. It definitely was not something that took away pain due to herniated discs. Also, if you have hypersensitive skin…there are areas where they set the pins that are “very important areas” that hurt & are uncomfortable for me. These needles are set in the skull & on the top of the feet.

It may work for some people, but not all.

Rich Reifsnyder

Good Morning, Opiod Medication originated in the 7th Century China and is an effective and cheap way to relieve chronic pain.Why is this government so hellbent to make Disabled Intractable Chronic Pain Patients suffer torturous pain from forcibly taking away their medication?Why are we tortured and Heroin Addicts have a safe house,free needles and Narcan available to bring them out of respatory depression or failure?Why don’t the diversion agents find out where they bought the Heroin instead of Bounty Hunting Pain Specialists?The CDC admitted their OD Death Data was wrong,actually the Biased Guidelines and all the data from the media and government is fictitious and wrong.Soon the suicides from Disabled Veterans And Intractable Chronic Pain Patients will be higher then the OD Deaths from forcing millions off the pain medication they been stable on for years!Pain Patients aren’t going to Addiction Centers or to the Streets for Pain Releif,they are on the couch or bed bound suffering,why?Millions signed Pain Contracts,submit urine tests and jumped through every hoop,and now we are abandoned by our government and fellow citizens call us drug seekers.Karma is a bitch,all these people doing this to us are one accident away from being abandoned like us!Most alternatives that come out every other day aren’t working effectively,In the 7th Century China figured out what was effective for Chronic Pain And it’s not yoga,mind/body approach and the rest of the [edit] Lies!

Christine

Ok! Big Deal! At least the Low Back Chronic Pain Community can celebrate!
What are the rest of us supposed to do?
How about approving an
” Alternative Medicine” reimbursement category?
Whereby any ” Altetnative ” medicine therapy deemed successfully used by the( Patient & Therapist) documented in the treating therapist notes be retroactively be paid.
Now that would be something all of us could be happy about having ” Alternative Medicine ”
Therapy treatment paid.
Like all the treatments we already paid for while on drug therapy Because none of the recommended alternative drug therapies we have already undertaken have not been paid for by any insurance system;
Private or Government Funded?

Who’s kidding who? I don’t know anyone who hasn’t paid out of pocket for ” Alternative Medicine
Treatments ” that have been recommended for solutions to Chronic Pain Patients diagnoses.
It’s what all of us have been doing the best we can without payment assistance.
Just approve to name the category of payment something applicable to all the money all ready being spent!
Now that’s something you won’t see anyone do! They would rather piece – meal payment categories ( one-slow-step-at-a-time) to keep ” pain patients ” paying their own way ( out of pain).
Isn’t that really what this is all about?
MONEY! IT’S ALWAYS ABOUT THE MONEY!

April Dawn

Acupuncture can be a helpful supplementary tool. I am using it as such now. However, it is just another sign of the level of denial, politics, and lack of any form of compassion that Acupuncture could even be considered as a replacement for the very successful and life saving opioid medications.